Cross My Heart and Hope to Write


Saturday, March 16, 2013

The Benefits of Expressing Yourself

I recently had the pleasure of hosting an informational event on the campus of Stony Brook University in Stony Brook, NY, discussing the psychological and physical benefits of expression (poetry, art, music, dance, and drama). The event was called "Health and Creativity: A Night of Poetry and Wellness," and represented a dual effort between the CHILL Peer Education internship program, which educates students on mental health issues on campus, and the "Spoke the Thunder" literary magazine that I helped found.
The event entailed a lecture-style discussion, presenting the findings of a literature review in psychological journals, interspersed with poetry readings from students (myself included) and local performers. Though I knew there were benefits, I was sincerely surprised when I began compiling the information, reading through the literature, and gathering materials for inclusion in the event. I was so surprised, in fact, that I wanted to share what I found with others. Below, you'll find a break down of the information I presented and the sources from which I got the information. All the more reason for you to get out there and express yourself!

The first study I stumbled on was one that looked at how poetry could be used to regulate the emotions of Iranian girls. The researchers found that "the use of poetry as an intervention technique plays a significant role in reducing signs of depression, anxiety and reported stress" (Mohammadian, et al., 2011). As will become clear with other sources, poetry can be used as an emotional stabilizer, which shouldn't come as a surprise to anyone. Another incredible article explored the relationship between humanities classes taken by medical students and their abilities to empathize with their clients. Shapiro & Rucker (2003) report: "Systematic research conducted on specific aspects of the humanities medical student curriculum shows significant improvements in self-reported empathy and attitudes regarding the usefulness of humanities to ongoing professional development." Taking humanities courses, particularly engaging in poetry writing, helped medical students to embody the experience of their clients. In another study, looking at how poetry can be used to help people cope with caring for family members with dementia, "The overarching theme gleaned from the data was that of self-affirmation. […] A prototype example of self-affirmation was the child caregiver who demonstrated less depression and burden as the study progressed along with greater self-transcendence and resilience… She noted that writing poetry as a participant in the study affirmed her confidence in herself. She voiced renewed faith that she could meet the challenges of care giving" (Kidd, Zauszniewski, & Morris, 2011). Writing poetry than could be used to build confidence and self-esteem. It also seemed to help care givers become more in-tune with themselves in the writing process: "As they did so, they became more aware of personal strengths and weaknesses, ultimately becoming more accepting of themselves in the process." In addition to these benefits, nine subthemes of "achievement, catharsis, increased acceptance, greater empathy, reflection, greater self-awareness, fun and creative, positive challenge, and helping others" emerged. The researches also found incredibly moving results, such as this: "One touching example was provided by a female caregiver irritated by the constant meaningless laugh of her spouse. After she wrote a poem about her feelings, she realized that his laugh was the only sound left to her husband; suddenly, it became something to hold onto and to preserve." Poetry, than, seemed to provide a means for people to slow down, appreciate their surroundings, and reflect on their situation. A similar paper employed poetry to help people surviving with severe illnesses (cancer particularly) cope with their affliction. Rickett, Greive, & Gordon (2011) recorded self-reports like this one: "A woman who had received treatment for breast cancer said: 'I was doing nothing – virtually hibernating at home. Worried about finances, worried about what I was going to do, because I had to retire quickly ... and I thought it would at least give me a little bit of something – something to hang my life on.' Afterwards she said: '[The course] gave me greater determination to make something of it. Not just sit around and think "well, my life is over", but "this in fact is a new beginning and I can do new things and I can start off again'". Tying it in to the previous study, medical practitioners and clinicians seem to be lacking in a particular field of treatment: "One participant started the course 2 years after being diagnosed with endometrial cancer: 'One of the reasons I wanted to do this writing, I feel like I need to draw more strength from within ... The oncologists are wonderful at what they do ... it’s about killing the cancer cells and that’s really great, but there is also a place for having those other contacts for healing the illness'. After the course, she said: '[It was] really enriching, because I’ve missed working and ... it was really nice going to do something and exercising your brain. ... Poetry has given me an outlet to try to untangle some of the confusion within'". Poetry, in some miraculous way, reconnects people with themselves, their world, and their life, in ways few seem to appreciate, although, I think us poets have known this all along. It can be used to connect and motivate people towards common goals. Sargent (1979) perhaps put it perfectly in his examination of poetry therapy in social work settings: "The members soon realize their thoughts, their feelings are shared across time and across culture. They have a common bond – not just with the writer but with each member of the group."
Music too seems to evoke something within us, and I found a plethora of evidence to support this. One study (Labbe, et al., 2007) compared participant's preferred genre of music for relaxation, classical music, heavy metal, and sitting in silence. The findings of the study were quite interesting: "Listening to self-selected and classical music produced increased feelings of relaxation as well as sitting in silence but not for the heavy metal condition. Listening to classical and self-selected music elicited reductions in state anxiety after exposure to a stressor. Interestingly, those participants who listened to heavy metal music not only experienced greater levels of state anxiety but were even more anxious after listening to the heavy metal music than when they were being stressed." I personally find heavy metal to be quite soothing (hell, I've fallen asleep to it!), though I sympathize with their participants. Self-selected music also resulted in the lowest rating of anger among the participants. So, if you're angry or just need to unwind, go listen to your favorite music, you'll feel better. Probably the most comprehensive and interesting article was a literature review itself, comprising a huge amount of information on the psychological effects of music. Yehuda (2011) wrote: "In more than half of the reviewed studies, a beneficial effect of music was found. The type of music presented was soothing (i.e. 60–80 beats per minute), and in the majority of the studies [...], self-selected music was used." The article contains all kinds of comparisons of how music can effect our neurological functioning, such as the following: "One example, of many, that demonstrates how music can influence neurological functions is given in a report that the amplitude of a startle eye blink reflex was larger and its latency shorter during unpleasant music compared with pleasant music, suggesting that the defensive emotional system is modulated by music (Roy et al. 2009). More profound effects are given in reports that demonstrates that musical training enhances activation and development of certain neuronal structures including cortex, amygdala, hippocampus and hypothalamus and improves plasticity and neurogenesis (Boso et al. 2006; Fukui and Toyoshima 2008; Hyde et al. 2009a, b)." The review also found that cortisol, a neurostransmitter in the brain released in stressful situations, is significantly reduced when exposed to music. Music also appears to play upon a strange and compelling physical phenomena: "It seems that music promotes relaxation via physiological and/or psychological entrainment. Entrainment is a physics principle, in which two objects vibrating at similar frequencies tend to cause mutual sympathetic resonance and vibrate at the same frequency. Entrainment is achieved using music to directly elicit relaxation. Musical stimuli and physiological processes (heartbeat, respiratory rate, blood pressure, temperature, adrenal hormones) are composed of vibrations that occur in a regular, periodic manner and consist of oscillations. Musical stimuli, specifically rhythm and tempo, can be used as a synchronizer to influence changes in physiological responses (i.e. heartbeat, respiration, blood pressure) through entrainment (Thaut 2003)." Perhaps the strangest finding I came across was a study that compared levels of negative emotions after watching a humorous movie, listening to music, and performing aerobic exorcises (Szabo, Ainsworth, & Danks, 2005). "The results of this experimental study demonstrate that watching an episode of entertaining humorous video or listening to new age music is at least as effective as a bout of moderate intensity stationary cycling in improving affect by decreasing TMD [total mood disturbance] which is an aggregate measure of negative affect." They researchers later suggest it is better to watch a funny movie than to go out and ride a bike. The last article I stumbled on compared the physiological responses of professional singers and amateur singers as they performed (Grape, et al., 2003). "The results indicated marked differences between professionals and amateurs with regard to physiological and emotional states. The professionals were more physiologically fit for singing, but did not experience the same well-being as amateurs seemed to do. The amateurs experienced more well-being and were clearly more enthusiastic. They also reported increased joy after the lesson, which the professionals did not." This finding is likely due to the fact that performers are concerned more with their performance than the actual act of singing. It can be inferred, therefore, that singing in the shower is far better for you than singing on stage. 
Art, strangely, took some digging to find significantly beneficial evidence. An art therapy group working with schizophrenics reported that, "Most therapists stated that image making helped ease personal difficulties through development of self-control [...] and helped patients identify feelings [...] Less than half [...] endorsed the view that a sense of mastery achieved through the acquisition of new skills was a key mechanism of action" (Patterson, et al., 2011). The creation of images for people with schizophrenia helps them "to express difficult emotions, improve capacity to communicate with others," a particularly hard act for them, "and supports the resolution of internal conflict." Another article looked at a group of at-risk adolescents as they worked together to build a city diorama out of cardboard and other materials (Slayton, 2012). "The group became a mutual exchange of respectful interactions—a community building a community—with the art product as the container for both the said and the unsaid." It is an incredible example of how art can be used to bring people together to solve social issues and motivate others into making a difference in the world. Photography (and even cinema) too can be a powerful tool in teaching people understanding and appreciation by offering incite into a person's world-view. Erdner & Magnusson (2010) found that, "Participants in the study […] have reported that this technique has yielded a more profound level of reflective thinking than interviews alone." The photos also assist the therapist in gaining an understanding of how their client sees the world. People suffering from severe mental illness also tend to lack verbal skills and competence, and pictures can provide a window into the life they may not be able to describe in detail. "Moreover, beautiful pictures stir deeper elements of human consciousness than words do." 
What about dance? It is not the first thing that comes to mind when we say "expression," but dance is used all over the world in the presence of high emotions. The following quote was taken from an article that compared the benefits of Hatha Yoga and African dance (though the specific dance style was not specified) to a biology class: "As hypothesized, African dance and Hatha yoga significantly decreased perceived stress and negative affect, compared to the biology class. Positive affect was significantly increased in African dance, significantly decreased in biology class, and did not change reliably in Hatha yoga" (West, et al., 2004). Yoga itself can be seen as a form of expression, but coupled with African dance, "these interventions aimed at reducing perceived stress may be effective in reducing stress and distress." Lane & Hewston (2003) explored mood changes following a modern-dance class. "Findings from the present study show that dancers report mood enhancement following the Limon style dance class as evidenced by increased vigor. […] The Limon dance technique should lead to maximizing effect on mood benefits." One important aspect of the study was that competition, as you can imagine, lead to increased stress. Once again, undertaking different methods of expression seems to be far more beneficial in the form of a hobby than a serious endeavor.
Drama, or acting in general, can also be beneficial (to some). Many people have heard of music therapy or art therapy, but drama therapy? We can define drama therapy as "… based on elementary theatrical exorcises starting from easy, simple motor exorcises, voice training, and ways of expressing emotions through a simple form of mime, progressing to group mime. In addition to these exorcises, use is made of role play, consisting of recreating daily life situations in which the patients are able to practice difficult tasks with which they might be faced in real life. […] These activities play an important part in preparing patients for further stages of therapy..." (Bielanska, Cechnicki, & Budzyna-Dawidowski, 1991). Psychodrama, a similar technique employed in psychotherapy, "is the process of enacting and reenacting past concerns and imagining the situation reoccurring in a present form, allowing patients to uncover thoughts and feelings that may not be accessed solely through talk therapy. […] The acting method aims to encourage communication, clarify issues, enhance physical and emotional well-being, and foster skill development. As an action-oriented technique or a clinical role-play, psychodrama provides a context in which individuals examine habitual patterns of reacting to certain problems and discover alternative ways to respond in a safe, supportive environment" (Konopik & Cheung, 2013). In their study, they used psychodrama in a group setting and found that being able to share your struggles with others allowed for an opportunity to work through them, gain feedback, and receive social support. Being able to reenact, relive, and change the outcome of something that may have happened in the past gives people an opportunity to take control of past events and to own them in the present. Indeed, participants "learned that once their past responses were enacted in the here-and-now environment, they could gain control of their feelings. Individual protagonists discovered hidden personal strengths, leading to a perception of improved self-esteem. As a group, the enactments helped these patients learn how past issues influenced current functioning and enabled them to make a connection between the two. Through their increased insight, the patients were able to view their interpersonal conflict through a new perspective." Acting is not just make believe - it is a process of coping, understanding, and control. It provides a way for people to literally face their pasts.   

1. Mohammadian, Y., Shahidi, S., Mahaki, B., Mohammadi, A. Z., Baghban, A. A., & Zayeri, F. (2011). Evaluating the use of poetry to reduce signs of depression, anxiety and stress in Iranian female students. The Arts in Psychotherapy, 38(1), 59-63.
2. Shapiro, J. & Rucker, L. (2003). Can Poetry Make Better Doctors? Teaching the Humanities and Arts to Medical Students and Residents at the University of California, Irvine, College of Medicine. Academic Medicine, 78(10), 953-957.
3. Kidd, L. I., Zauszniewski, J. A., & Morris, D. L.(2011). Benefits of a Poetry Writing Intervention for Family Caregivers of Elders with Dementia. Issues in Mental Health Nursing, 32, 598-604.
4. Rickett, C., Greive, C., & Gordon, J. (2011). Something to hang my life on: The health benefits of writing poetry for people with serious illnesses. Australasion Psychiatry, 19(3), 265-268.
5. Sargent, L. (1979). Poetry in Therapy. National Association of Social Workers, Inc.  
6. Labbe, E., Schmidt, N., Babin, J., & Pharr, M. (2007). Coping with Stress: The Effectiveness of Different Types of Music. Applied Psychophysiol Biofeedback, 32, 163-168.
7. Yehuda, N. (2011). Music and Stress. Journal of Adult Development, 18, 85-94.
8. Szabo, A., Ainsworth, S. E., & Danks, P K. (2005). Experimental comparison of the psychological benefits of aerobic exercise, humor, and music. Humor: International Journal of Humor Research, 18(3), 235-246.
9. Grape, C, Sandgren, M., Hansson, L., Ericson, M., & Theorell, T. (2003). Does Singing Promote Well-Being?: An Empirical Study of Professional and Amateur Singers during a Singing Lesson. Integrative Physiological & Behavioral Science, 38(1), 65-74.
10. Patterson, S., Debate, J., Anju, S., Waller, D., & Crawford, M. J. (2011). Provision and practice of art therapy for people with schizophrenia: Results of a national survey. Journal of Mental Health, 20(4), 328-335.
11. Slayton, S. C. (2012). Building community as social action: An art therapy group with adolescent males. The Arts in Psychotherapy, 39(3), 179-185.
12. Erdner, A. & Magnusson, A. (2010). Photography as a Method of Data Collection: Helping People With Long-Term Mental Illness to Convey Their Life World. Perspectives in Psychiatric Care, 47, 145-150.
13. West, J., Otte, C., Geher, K., Johnson, J., & Mohr, D. C. (2004). Effects of Hatha Yoga and African Dance on Perceived Stress, Affect, and Salivary Cortisol. Annals of Behavioral Medicine, 28(2), 114-118.
14. Lane, A. & Hewston, R. (2003). Mood Changes Following Modern-Dance Classes. Social Behavior And Personality, 31(5), 453-460.
15. Bielanska, A., Cechnicki, A., & Budzyna-Dawidowski, P. (1991). Drama Therapy as a Means of Rehabilitation for Schizophrenic Patients: Our Impressions. American Journal of Psychotherapy, 125(4), 566-575.
16. Konopik, D. A. & Cheung, M. (2013). Psychodrama as a Social Work Modality. Social Work, 58(1), 9.

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